During the stormy debate over his healthcare plan, President Barack Obama promised his program would not "pull the plug on grandma," and Congress dropped plans for death panels and "end of life" counseling that would encourage aged patients from partaking in costly medical procedures.
Opponents of Obama's plan, including former vice-presidential candidate Sarah Palin, dubbed such efforts as "death panels" that would encourage euthanasia.
But on Dec. 3, the Obama administration seemingly flouted the will of Congress by issuing a new Medicare regulation detailing "voluntary advance care planning" that is to be included during patients' annual checkups. The regulation aimed at the aged "may include advance directives to forgo aggressive life-sustaining treatment," The New York Times reported.
The new provision, which goes into effect Jan. 1, allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex decisions families face when a loved one is approaching death. Critics say it is another attempt to limit healthcare options for the elderly as they face serious illness.
Incoming House Speaker John Boehner said during the healthcare debate: “This provision may start us down a treacherous path toward government-encouraged euthanasia.”
Specifically, the measure was known as Section 1233 of the bill the House passed in November 2009. It was not included in the final legislation, however. It allowed Medicare to pay for consultations about advance care planning every five years. In contrast, the new rule allows annual discussions as part of wellness visits.
Elizabeth D. Wickham, executive director of LifeTree, a pro-life Christian educational ministry, told the Times that she is concerned that end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death.
“The infamous Section 1233 is still alive and kicking,” Wickham said. “Patients will lose the ability to control treatments at the end of life.”
The rule was issued by Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, according to the Times. He is a longtime advocate for rationing medical procedures for the elderly.
Before Obama tapped Berwick for the Medicare post, Berwick had long applauded Britain's National Health Service, which uses an algorithm to determine whether the aged are worthy of additional expenditures for medical care and advanced treatments.
Berwick has argued that rationing will have to be implemented eventually, stating, “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”
Seniors appear to be a major target for precious resources under the Obama healthcare plan. According to the Congressional Budget Office, the Obama plan cuts nearly $500 billion in Medicare benefits to seniors as the federal government adds 30 million uninsured Americans to private and public healthcare systems.
The cost of caring for the elderly has not been lost on Berwick.
“The chronically ill and those towards the end of their lives are accounting for potentially 80 percent of the total health care bill out here . . . there is going to have to be a very difficult democratic conversation that takes place,” he said.
During the heated healthcare debate, supporters of the Obama plan vigorously denied that rationing for seniors would take place and scoffed at "death panel" critics such as Palin.
Last month, however, economist and New York Times columnist Paul Krugman told ABC News that rising Medicare costs could be dealt with only by "death panels and sales taxes."
He added: "Medicare is going to have to decide what it's going to pay for. And at least for starters, it's going to have to decide which medical procedures are not effective at all and should not be paid for at all. In other words, it should have endorsed the [death] panel that was part of the healthcare reform.’"
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